Erythropoietin Guide

Erythropoietin (EPO), sometimes referred to as hemopoietin or hematopoietin, is a hormone produced by the kidneys that regulates the production of red blood cells within the bone marrow. These cells in the kidneys are sensitive to the oxygen content in the blood and release EPO when the oxygen content in the blood is low. EPO then stimulates the bone marrow to produce more red blood cells in an effort to increase the oxygen-carrying capacity of the blood. Hypoxia, low levels of oxygen, can occur as a result of numerous conditions, including anemia, lung disease, the use of certain medications, and overexertion.

People use erythropoietin to increase the absorption of oxygen in their system, reduce fatigue, and improve their endurance due to its ability to increase the rate of red blood cell production. It is also believed to increase metabolism and healing abilities due to the enhanced effects of increased red blood cells.

Blood Doping

According to sources, such as the book Doping in Sports and a review article in the journal Sports Medicine, artificial erythropoietin has been used as a means to increase athletic performance, and its use was first identified in the 1980s. The use of artificial EPO has been linked to numerous blood doping scandals in sports like professional cycling, and there are claims that blood doping is still a common practice in many different sports at both the amateur and professional level.

Artificial EPO (often abbreviated as r-HuEPO) was designed in the 1980s to assist individuals who have kidney disease, anemia, and other conditions that result in problems with hypoxia. It has also been used to treat people with cancer or HIV who are undergoing treatments that can reduce red blood cell count.

EPO has very little utility in increasing an individual’s appearance by reducing body fat or increasing muscle mass, but it does enhance performance in endurance athletes. Its use does not result in significant psychoactive effects such as euphoria, and it is not considered to be a significant drug of abuse in the same manner that prescription medications like opiates, benzodiazepines, stimulants, etc., are potential drugs of abuse. Athletes who use EPO to enhance their performance typically inject it directly into their system or get it through blood transfusions.

The World Anti-Doping Agency (WADA), an independent agency that monitors and collects information about illegal doping in sports, reports the following:

Estimates regarding the prevalence of blood doping in sports vary depending on the sport. They range from 1 percent to 48 percent of athletes.

The overall prevalence of blood doping across all sports is estimated to be right around 13-15 percent.

About 1-2 percent of EPO test results are false positives.

The presence of EPO in the system is very difficult to detect because it is a naturally occurring substance. In one study that followed participants three weeks after an injection of r-HuEPO, only about 4 percent of participants tested positive.

The approach to accurately identifying blood doping in athletes has resulted in the development of numerous methods to detect EPO, including more advanced procedures that help to increase the accuracy of the testing and reduce false positives. Depending on the sport and the history of the athlete, the sanctions for blood doping may involve a total ban from participation in the sport, fines, or other actions.

Problems with Using EPO

In addition to the obvious ethical concerns regarding the use of erythropoietin in athletic competition, there are potential dangers associated with its use, per the book Sports Medicine.

Numerous injections of EPO may thicken the blood, resulting in cardiac strain.

The increase in the viscosity of the blood can lead to an increased risk for individuals to develop heart attack, blood clots, and stroke.

The danger is particularly salient when an individual’s heart rate slows down, such as during sleep or while at rest.

The use of erythropoietin may increase the risk of dehydration for athletes.

There is evidence that habitual use of EPO may increase the risk for certain forms of cancer.

There is an increased risk for damage to the liver and pancreas.

There is an increased potential for allergic reactions.

There are some reports of individuals who inject EPO experiencing seizures.

Risks associated with injecting drugs of any type are present, such as an increased risk to develop blood-borne diseases, collapsed veins and arteries, etc.

The black market for performance-enhancing drugs like EPO has expanded, and some of the counterfeit versions of the substance on the market may not be effective and may contain substances that can harm the individual. Obviously, one of the most salient issues associated with any form of performance-enhancing drug is the use of these substances by young individuals as an attempt to improve their athletic performance in high school or college. Significant increased risks occur to individuals who are still physically developing and use performance-enhancing substances like EPO.

The black market for performance-enhancing drugs like EPO has expanded, and some of the counterfeit versions of the substance on the market may not be effective and may contain substances that can harm the individual. Obviously, one of the most salient issues associated with any form of performance-enhancing drug is the use of these substances by young individuals as an attempt to improve their athletic performance in high school or college. Significant increased risks occur to individuals who are still physically developing and use performance-enhancing substances like EPO.